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Reaction at the bacillus Calmette--Guérin inoculation site in patients with Kawasaki disease
Chi-Chieh Lai1, Pi-Chang Lee, Chih-Chien Wang
1Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
Background:
The bacillus Calmette-Guérin (BCG) reaction is not included in the classical clinical criteria for Kawasaki disease (KD). However, a reaction at the BCG inoculation site has been mentioned among the "other clinical findings" that are present in about 30-50% of KD patients. The objective of this study was to investigate the clinical characteristics of KD patients with reactions at the BCG inoculation site.
Methods:
A retrospective study of all patients diagnosed with KD between September 2000 and August 2010 was performed. The clinical presentations, laboratory results, treatment outcomes, and coronary artery abnormalities in the BCG-reactive [BCG(+)] and BCG-nonreactive [BCG(-)] groups were analyzed and compared.
Results:
In total, 145 patients with KD diagnosed at our institution were included; 46 (31.7%) had a reaction at the BCG inoculation site. The BCG(+) group was younger than the BCG(-) group. Laboratory results showed higher white blood cell counts, platelet counts, and serum potassium levels, and lower low-density lipoprotein levels in the BCG(+) group. The BCG(+) group had a shorter fever duration before intravenous immunoglobulin treatment and a shorter total fever duration than the BCG(-) group. Multivariable logistic regression analysis showed that the age at diagnosis was the only factor significantly associated with a reaction at the BCG inoculation site in KD patients.
Conclusions:
In countries with a national BCG vaccination program, a reaction at the BCG inoculation site could be a useful and early diagnostic sign of KD among younger patients, especially those younger than 6 months.
Insights
A reaction at the bacillus Calmette-Guérin (BCG) inoculation site may indicate Kawasaki disease (KD) in infants. Younger Kawasaki disease patients with BCG site reactions showed distinct clinical and lab findings, suggesting it as an early diagnostic sign.
Area of Science:
- Pediatrics
- Immunology
- Infectious Diseases
Background:
- The bacillus Calmette-Guérin (BCG) inoculation site reaction is not a primary diagnostic criterion for Kawasaki disease (KD).
- This reaction is noted in 30-50% of KD patients as an "other clinical finding."
- Investigating BCG site reactions in KD patients is crucial for understanding its diagnostic utility.
Purpose of the Study:
- To investigate the clinical characteristics of Kawasaki disease patients with reactions at the BCG inoculation site.
- To compare BCG-reactive and BCG-nonreactive KD patient groups.
Main Methods:
- A retrospective study analyzed 145 KD patients diagnosed between September 2000 and August 2010.
- Clinical presentations, lab results, treatment outcomes, and coronary artery abnormalities were compared between BCG-reactive (BCG(+)) and BCG-nonreactive (BCG(-)) groups.
- Multivariable logistic regression identified factors associated with BCG site reactions.
Main Results:
- 31.7% of KD patients (46/145) exhibited a BCG inoculation site reaction.
- BCG(+) patients were younger, had higher white blood cell and platelet counts, elevated serum potassium, and lower low-density lipoprotein levels.
- BCG(+) patients experienced shorter fever duration before and after intravenous immunoglobulin treatment.
- Younger age at diagnosis was significantly associated with BCG site reactions.
Conclusions:
- A BCG inoculation site reaction can be an early diagnostic indicator for Kawasaki disease in countries with national BCG vaccination programs.
- This sign is particularly useful for diagnosing KD in younger patients, especially those under six months old.
- The distinct clinical and laboratory findings in BCG-reactive KD patients warrant further investigation.
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